Trans Healthcare Action (THA) is aware of the ongoing issues with accessing care through GenderGP that are affecting trans people throughout Ireland. Some of you may be looking for support to ensure that you don’t experience an interruption in the essential gender-affirming care you currently receive from GenderGP.
We have developed this guide to provide you with information on alternative gender-affirming care providers and how to transition your care to them.
As the primary public gender clinic in Ireland has a wait list currently estimated at over a decade, we have focused this guide on other options.
In order to transition your care from GenderGP, you should first request your summary of care and treatment record from them. This will allow you to have a full history of your treatment to take to another doctor. We recommend that you submit your request as soon as possible given that it could take some time to receive. You will often need this documentation for the alternative care options below.
To request your summary of care from GenderGP, send the following email:
Subject: Summary of Care and Treatment Record Request
Message:
To whom it may concern:
I’m requesting a summary of care and a full treatment record for myself, [insert name], to be sent to me at [insert email address] (OPTIONAL: and to my GP at [insert email address]). This must include all of my medical records, including the Appraisal Pathway Form, Information Gathering Session Reports, Treatment Summaries, Treatment Reviews, Follow-Up Session Reports, Progress Reports, Blood Test Results, and any other session reports, notes, and/or documentation associated with my care. This report must include the name of the doctor(s) who have conducted medical reviews of my care. Ideally, this should be the prescribing doctor registered with the Irish Medical Council.
I look forward to your prompt response.
Regards,
[Your Name]
If the above message does not work, you can send a new email with the body content to include a GDPR request with the text “Under General Data Protection Regulation, Article 3 ("Territorial scope" ) Section 2; I as a data subject who is within the European Union am requesting compliance with my rights under this regulation.” However, this may take a month to receive your data.
If you are no longer able to access care through GenderGP and urgently need to extend supply of your gender-affirming hormone therapy prescriptions, you can attempt to access a prescription extension or emergency supply through your pharmacy. This guide is a primer for what you can ask for and things to consider. Your job is just to be able to communicate your problem to the pharmacist, who will usually be able to help you in some way.
In many cases, pharmacists are permitted to extend prescriptions by up to three months, providing you with an extra one to three month supply of medication. However, this can depend on a number of factors and is at the discretion of the pharmacist depending on your individual circumstances. Ask your pharmacist directly and see what they can do for you in the absence of clear guidance from their regulator.
Emergency supply, like any of these processes, is down to the discretion of the pharmacist. Pharmacists are encouraged by the regulator to engage in ethical decision-making, with a focus on patient safety. So pharmacists will usually have to acknowledge that it is wrong and potentially harmful to leave a patient without medication. The vast majority of pharmacists should be happy to provide you with emergency supply. Please note: some medicines used in trans healthcare are not licensed for use in Ireland, e.g. blockers, so it may be harder to get an emergency supply of them.
If you meet the criteria for an emergency supply, the pharmacist may supply you with up to 5 or 10 days of medication, based on a judgement call in the absence of clear guidance. Explain to the pharmacist that you are between prescriptions and ask how they can help. As an example you may say, “Would it be possible to even give me 5 tablets and/or 1 bottle of gel to tide me over? I’m not sure if this will be enough to maintain me while bridging to a new service, but I really need your help.”
For tablets and patches: A pharmacist will be able to supply the amount of tablets or patches you would typically take across 5 or 10 days, based on a judgement call in the absence of clear guidance.
For gels: A pharmacist cannot split packs of liquids or semi-solids such as gels to facilitate emergency supply. It is therefore regular practice to provide you with a full pack of gel. This means that under current and previous emergency supply rules, the amount a pharmacist can supply you is 1 pack of testogel or 1 pack of (o)estrogel, so you can get a one month supply.
If you face issues accessing an emergency supply from your pharmacist, you may want to try requesting this from another pharmacy. If you have questions still unanswered, reach out to Trans Healthcare Action at action@transhealthcare.ie and we may be able to give you some advice in the context of your situation.
The most sustainable, efficient, and effective option for gender-affirming care is through your primary care provider. As GPs prescribe hormone therapy in their practice every day, most GPs should have the knowledge to provide this care to their trans patients.
Many GPs feel that they are not competent in the provision of gender-affirming hormone therapy, however, so it may not be easy to convince your GP to provide this care. If you feel that your GP is generally supportive and you are comfortable with them, you can ask that they take on management of your hormone therapy.
Feel free to edit and print off the following letter, attach your summary of care and treatment record from GenderGP, and bring this packet to an appointment with your GP. Alternatively, send the documents in an email to your GPs medical practice. Use all of this information to help you ask your GP to take on your hormone therapy.
Dear [Doctor Name],
I am a patient of yours and I am transgender, meaning that my gender identity is different to the sex I was assigned at birth. I am currently receiving gender-affirming care through a private service so that my hormone profile matches my gender. This treatment is meant to be available to me through the HSE, but due to very long waiting times and a lack of provision of local services, I am asking that you help me with this.
The waiting list for the National Gender Service is stated at 3-3.5 years and estimated by the community to be longer than 10 years, and as such I have chosen to access care privately to prevent further unnecessary delay, which would be damaging to my mental health and general wellbeing. However, the changes in the private service I have been using have forced me to seek alternative options for my care, I would like to request that you take over my hormone therapy through a bridging prescription and provide blood testing [OPTIONAL: and the administration of any injections I might need] in the meantime as I investigate my options.
I am seeking this support from you from you as [GIVE PERSONAL REASONS IN BRIEF: You might mention A) how long you’ve been waiting, B) how long you’re likely to wait, C) the impact this has had on your mental/physical health, and D) if you’ve considered or are self-medicating. It’s recommended you keep this to 2-5 sentences – you can discuss this more in depth with your GP at your
appointment].
I have attached to this letter my summary of care and treatment records from the gender specialists at the private service I have been using, which will provide all information for you to continue my treatment. This includes the medication I need, the dose and strength, and all information about what treatment I have received. I am asking that you take on the ongoing prescription of my gender-affirming hormone therapy (GAHT) and carry out the necessary blood tests to monitor my hormone levels.
Some primary care providers (PCPs) feel that gender-related healthcare falls outside their expertise, but the World Professional Association for Transgender Health Standards of Care Version 8 “supports the argument GAHT can be prescribed by PCPs or other non-specialists—’Considering barriers to health care access and the importance of GAHT to this population, it is imperative that PCPs are able and willing to provide GAHT for TGD patients.’ (Shires, 2017).”
WPATH further notes that “PCPs are commonly called upon to provide care for a broad range of conditions and needs, including those with which they may have had limited or no prior experience. Often this involves accessing commonly used and readily available reference sources, such as professional society guidelines or obtaining a subscription to online knowledge bases. PCPs are advised to use a similar approach when asked to provide basic GAHT care by using the Standards of Care as well as other readily accessed resources (Cheung et al., 2019; Hembree et al., 2017; Oliphant et al., 2018; T’Sjoen et al., 2020). It should be noted most of the commonly used medications in gender-affirming regimens are familiar to everyday primary care practice, including, but not limited to, testosterone, estradiol, progesterone and other progestagens, and spironolactone.”
I appreciate you taking the time to read through this carefully. I know this is a lot of information, especially in the current situation, and that GPs do not always have good access to trans-related healthcare resources. I ask, too, that you consider that transgender people are disproportionately responsible for being self-advocates and teachers about our own healthcare. In this stressful and uncertain time, it would be a huge reassurance to know that [SURGERY NAME] is able to support me in receiving continued access to this vital treatment.
If you do not feel able to help then I request that you share your decision in writing with your clear reasons for not providing this support to me.
Yours sincerely,
[Your Name]
Unfortunately, many GPs in Ireland are unwilling to provide hormone therapy or blood tests at this time. If you are not successful in convincing them to take on your care by providing them with your summary of care, treatment records, and the above letter, you may need to seek care from one of the below options. You can also reach out to Outhouse, TENI, and/or Trans Harm Reduction for information on GPs who may be more willing to support you.
The private services may allow you to transition your care more quickly, but they are often more costly than other options. We recommend that when considering other private services, you review this checklist from GenderKit to make an informed decision.
If you need support to pay for private trans healthcare, you may try reaching out to the Small Trans Library regarding their mutual aid fund for trans people who are out of work or struggling.
When transitioning your care from GenderGP to Gender Plus, to access this expedited pathway you must be over the age of 18 and have been on gender-affirming hormone therapy for at least 12 months. You must have your summary of care and treatment records from GenderGP ready in order to access their transition of care pathway.
The pathway and costs to transition care:
Important notes:
To get started, book the Transfer of Care Assessment appointment with Dr. Aidan Kelly online at https://ie.genderplus.com. As a reminder, this is for people over the age of 18 who have been on hormone therapy already with another service for at least 12 months. Do not book this appointment if you do not meet this criteria. You can watch a video from Gender Plus regarding transferring your care here.
The Gender Hormone Clinic is a nurse-led clinic based in London. When transitioning your care from GenderGP to The Gender Hormone Clinic (GHC) you must be over the age of 18 and have a diagnosis of gender dysphoria from a psychiatrist or psychologist. You should have your summary of care and treatment records from GenderGP ready to most effectively access care from the GHC.
The pathway and costs to transition care to the GHC if already established on hormone therapy:
Important notes:
To get started, send an email to info@thegenderhormoneclinic.com, specifying that you are based in Ireland and transitioning your care from GenderGP. You can also view patient reviews here.
If you would like to transition your care to the GHC but do not have a diagnosis, please check the How to access a diagnosis section below.
When transitioning your care from GenderGP to the Northern Gender Network, you must be over the age of 18. It will be helpful to have your summary of care and treatment records from GenderGP ready to share.
The pathway and costs to transition care:
Important notes:
To schedule an appointment, email admin@helijoubert.co.uk.
Anne Trans+ Health is a non-profit gender-affirming telehealth service. When transitioning your care from GenderGP to Anne Trans+ Health, you must be over the age of 18* and have an established history of treatment of at least 12 months to access their cheaper transition of care options. You will need your summary of care and treatment records from GenderGP ready as well as a current full health check blood test, including hormone levels, in order to access their transition of care pathway.
The pathway and costs to transition care:
Important notes:
To schedule an appointment and find out more, visit www.anne.health/membership, email hello@anne.health or call 0333 220 8966.
The only other digital trans health clinic we are aware of, Imago, is a new service that provides gender-affirming hormone therapy for people residing in the EU through an informed consent model.
Pathway and costs for care:
Important notes:
To find out more, visit www.imago.tg.
The above services are only a few of the options that may be available to you, not a comprehensive list. If you are seeking a fully online, informed consent-based service similar to GenderGP, such options are extremely limited across the EU. If you pursue a different private service, be sure to review this checklist from GenderKit when considering your options.
There are only a few endocrinologists in Ireland who provide trans healthcare and most are not taking on new patients. You can expect this route to take much longer than the above private services. If you need to access care quickly, you may want to explore other avenues.
Note: Dr. Marcia Bell may be closed to new patient intake.
Dr. Marica Bell operates a public list to which patients can be referred by their GP to her at University Hospital Galway’s Endocrine Unit. She also operates a private service through the Galway Clinic.
The pathway and costs to transition care to Dr. Marcia Bell:
Important notes:
Trans Harm Reduction (THR) is a volunteer-run, grassroots organisation supporting trans people in Ireland and Scotland to manage the risks associated with self-medicating. In the context of trans healthcare, self-medicating is the self-administration of gender-affirming hormone therapy without approval or oversight from medical professionals. They also organise laboratory testing of commonly used hormone therapy sources and supply free safe injecting supplies to anyone self-medicating in Ireland or Scotland.
If you cannot access hormone therapy through other routes and plan to start self-medicating, we highly recommend that you reach out to Trans Harm Reduction to help you manage potential risks and ensure that you are safe.
You can view their website at transharmreduction.org and contact them directly by emailing transharmreduction@protonmail.com.
If you do not have a diagnosis of gender incongruence or gender dysphoria from a psychiatrist or clinical psychologist and need one to transfer your care to an alternative service, we recommend that you seek this diagnosis from one of the below psychologists.
Dr. Brendon Glon assesses across 1-3 telehealth sessions, each booked for 90 minutes. The fee for this service is €350 per session. For those who are already undergoing transition and are transferring care providers, assessments will normally be completed in 1 session. Dr. Glon offers a free 15 minute initial phone consultation to anyone who might be considering booking. If you would like to schedule an initial phone call before booking, please email glon@truapsych.com. You can find out further information and book on their website.
Dr. Brian McGuire assesses in a single hour session either face-to-face in Galway or over Zoom. The assessment and report currently costs €350. Dr. McGuire does not work with people under 18 years old. You can contact Catherine at 12thecrescent@gmail.com regarding an appointment.
We recognise that facing changes in your gender-affirming care can be confusing and stressful. If you need support, we recommend that you reach out to TENI at office@teni.ie.
You can also find further information on accessing hormone therapy in Ireland at https://www.reddit.com/r/TransIreland/wiki/medicaltransition/hrtroi/.